How nurses improve fluid balance in acute kidney injury

4 Loop Diuretics …………………………………………………………………………………. 5 I. V. continuous vs. intermittent bolus diuretic infusion…………………………………………6 Renal perfusion…………………………………………………………………………………7 Dopamine and Fenoldopam……………………………………………………………………. Pathophysiology of Acute Kidney Injury and Fluid Balance In recent times, understanding the pathophysiology of Acute Kidney Injury has been complex and difficult to understand. Scientific and clinical research point out that the condition no longer affects the functionality of a single organ, but has developed into a syndrome where the kidney affects the roles played by multiple organs. If not properly managed, the condition is fatal, even though there are better outcomes for patients subjected to timely pharmacological or clinical measures. Among the most common causes of acute kidney injury includes ischaemia, which may occur due to various reasons. When physiological adaptations responding to a reduced blood flow compensate to a certain level and the delivery of oxygen and metabolic substrates become inefficient, cellular injury may occur leading to the failure of an organ.

Introduction Acute Kidney is a common condition caused by a wide range of factors and mostly leads to high instances of death and prolonged length of hospital stay among patients (Davis et al. The condition has led to many repercussions such as widespread suffering and high costs of healthcare expenses. According to the National Health Service, AKI costs over a billion pounds each year, a significant amount that can otherwise be invested in other sectors of the economy. To improve the challenge of Acute Kidney Injury, it is important to conduct a fluid balance monitoring to help manage the condition (Mehta et al. , 2007, p 31). An article by Chertow and colleagues on the statistics of Acute kidney injury, mortality, length of stay, and costs in hospitalized patients, provides a relevant base for study making it relatively more accessible and energy saving to put down credible research on how nurses can improve outcomes by improving fluid balance among acute kidney injury patients.

The second article used for the research paper has been authored by Davis and his colleagues and highlights the importance of fluid therapy in maintaining a well-balanced fluid loaded system. Also used in the paper is an article by Lingegowda and colleagues, which has explored the use of Prophylactic Nesiritide for the Prevention of Acute Kidney Injury Following Cardiovascular Surgery. Information was also obtained from the Medscape website that highlighted the recommendations for fluid balance in Acute Kidney Injuries. All the information culminating into the comprehensive research on how nurses can improve fluid balance in acute kidney injury cases were well thought, ethically analyzed and documented to bring out relevant and substantial remedies to the challenge which has increased mortality rates, especially among the already hospitalized.

Xiong and colleagues have also provided a reliable source of information used to develop the research. In their article titled, ‘the dose-dependent effect of nesiritide on renal function in patients with acute decompensated heart failure: a systematic review and meta-analysis of randomized controlled trials' they highlight the need to administer the right amounts of nesiritide as an overdose or underdose may cause further complications. Nurses have continuously embraced the use of fluid charts in healthcare to monitor the amount of fluid administered to patients, based on their conditions. Fluid charts also provide a reliable way of tracking a patient's fluid status; hence, the accurate clinical assessment and interventions can be developed based on available information on the documentation. The research is proficient and credible since all the sources used are well researched and directly relate to the approaches that can be used to improve fluid load among acute kidney injury patients.

Thus, it is crucial to maintain normal oncotic pressure to achieve normal fluid homeostasis and make diuretic procedures more effective. Loop diuretics Nurses can help improve fluid balance in patients with Acute Kidney Injury through the use of furosemide, which decreases oxygen consumption since it deters the NaK2Cl in the thick ascending limb. Administering furosemide in high doses in patients with Acute Kidney Injury waiting for dialysis procedures was found to improve fluid balance by enhancing better urine output without associated risks in renal recovery or death (Okusa et al. , 2013, p66). Persistency in administering furosemide has been found to improve outcomes in urine output among affected patients. intermittent bolus diuretic infusion Drug administration for patients with Acute Kidney Injury can either be through a bolus or as continuous infusion (Charles Patrick Davis, 2019, p1).

 Hawkins (2012) adds that when furosemide is administered using the Intermittent mechanisms, it is plausible that the drug concentrations may occasionally be subtherapeutic. On the other hand, adopting the continuous infusion gets rid of instances where sodium is compensatorily retained. An extrinsic analysis of Diuretic Optimization Strategies Evaluation trial on intermittent and continuous infusion administration shows little differences in terms of symptoms improvement, transformation in kidney functions, or urine output. According to Perner et al. Contrast found that Fenoldopam increased renal blood flow compared with baseline by 15. 8%, while 0. 45% saline reduced renal blood flow by 33. No impact was seen when radiocontrast-induced nephropathy (RCIN) was implemented. In a prospective, placebo-controlled, double-blind, multi-center randomized trial in patients with renal insufficiency, Fenoldopam had no effect of reducing the incidence of RCIN (33.

Aquaretics When fluid levels become abnormal in the body due to acute kidney injury challenges, other conditions such as hyponatremia may occur. Nurses can help improve the fluid balance of a patient by administering aquaretics such as IV sodium solution and the treatment of related symptoms such as nausea and headaches. On the other hand, it may sometimes be difficult to effectively manage a healthy fluid balance due to the challenges of weak renal activity and slow recovery from Acute Kidney Injury. Fluid balance is essential as it prevents further complications and acute illness. Nurses must remain focused not to administer excessive intravenous fluid therapy as it may lead to positive fluid balances and interstitial edema associated with organ dysfunction and adverse outcomes in acute illness (Schrier, 2010, p735) Contrary to perceived opinion, maintaining a positive fluid balance may worsen renal function and impede recovery from AKI.

, 2012, p201). To improve the outcomes based on these interventions; nurses may need to utilize the vasopressor therapy consistently and on time. Healthcare providers have traditionally utilized vasopressors to restore blood pressure in systematic vasodilatation (Prowle, 2010, p37). However, the use of vasopressors has been undermined by renal vasoconstriction, which causes ischemia. Nevertheless, the use of vasopressors can have an ultimate influence in maintaining fluid balance since it increases renal blood flow and urine output (Perren et al. , 2013, p239). In conclusion; it is much easier not to give fluid than to remove edema once accumulated. Furthermore, as soon as it can be hemodynamically tolerated, sodium and water balance should be neutral, or even negative, as was achieved in the FACTT trial (Prowle et al.

, 2010, p37). Achieving a neutral or negative fluid balance spontaneously during acute illness can be difficult. In the treatment of AKI in the ICU, use of intermittent hemodialysis (IHD) was found to be correlated with progressively positive fluid balances whereas CRRT enabled net fluid removal, even though CRRT was preferred for sicker, more hemodynamically unstable patients. Similarly, use of CRRT for initial treatment has been associated with higher rates of renal recovery than immediate use of IHD in critically ill individuals. These observations have been strengthened recently by the findings of a large, randomized, controlled trial that investigated the use of CRRT for the treatment of AKI in the ICU. Mostly, consideration should be given to the early initiation of CRRT—in advance of classic indications—if fluid balance cannot be adequately controlled with diuretic therapy.

This approach anticipates and limits the extent of fluid overload rather than treating its consequences. 9% saline compared to a balanced solution (Bennet et al, 2014, p614). An Australian prospective study subsequently found lower increases in creatinine, lower incidence of RIFLE ‘injury' and need for RRT in ICU patients treated with a chloride-restrictive approach as opposed to a chloride-liberal strategy (Science daily, 2019, p1). Based on the available evidence at this time, it appears that balanced salt solutions may be preferable for managing patients at risk of and with AKI. However, recent studies comparing the use of sodium bicarbonate to saline for preventing cardiac surgery-induced AKI failed to show any benefit from bicarbonate-containing fluids. Fluid Removal Sometimes healthcare professionals adopt fluid removal mechanisms to develop a well-balanced load of fluid in the body of a patient.

According to Bagshaw et al. , (2008), renal injury is a known biomarker of acute kidney injury caused by fluid balance challenges. Fluid balance load among patients with AKI requires that accurate and timely measures be taken by medical practitioners to help reverse the trend. Goldstein (2014) highlights the importance of appropriate procedures to ensure improved outcomes in fluid balance among acute kidney injury patients. Monitoring the pathogens or causative agents of these Kidney related problems can help achieve a timely diagnosis, treatment, and preventive options for future challenges ( Bagshaw et al. Besides, Besides being directional in attaining transformation, the approach utilizes both the emotional and practical components of change, a critical aspect of the change process that enables change agents to move towards the transformation objectives with ease and precision.

Lewin Kurtis' three-step change model identifies that change in a particular system focuses on unfreezing the status quo, moving to a new state before refreezing and making the change permanent. Ideally, all the standards for the transition to occur have to be set equal before change proponents develop well-confounded ideologies on the change enactment process (Hartzell, 2013). Lippitt’s phases of change and Havelock’s model are an extension of Lewin’s change theory. Lippitt’s approach describes change in further seven step strategy including Diagnosing the problem, assessing motivation and capacity for change, assessing change agent’s motivation and resources, selecting progressive change objects, maintaining the change and terminating the helping relationship (Kritsonis, 2005). Kotter's steps are easy to understand and interpret, also making his proposal likable, added to the fact that it allows for a more natural transition.

In conclusion, Acute Kidney Injury, which is one of the leading causes of deaths across various populations causes fluid imbalance that leads to complications and mortalities among hospitalized patients. Adequate research and strategies must be explored by medical practitioners, scientists and other healthcare stakeholders on how best the problem of Acute Kidney Condition that is associated with fluid load balance can be managed. Clinical measures such as the use of fluid balance charts, diuretics and aquaretics as well as pharmacological measures involving drug administrations have been found to be long term solutions to improve fluid balance among acute kidney injury patients. References Acheampong, A. Back to the future: revisiting Kotter's 1996 change model. Journal of Management Development, 31(8), pp. Balakumar, V. , Murugan, R.

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, Mildh, L. , Reinikainen, M. , Lund, V. and Parviainen, I. , Wald, R. , McCarthy, E. P. and Chertow, G. M.  Nursing times, 107(39), pp. Weiner, B. J. A theory of organizational readiness for change.  Implementation science, 4(1), p. e0131326 Yerram, P. , Karuparthi, P. R. and Misra, M. Fluid overload and acute kidney injury. SERVICE IMPROVEMENT PLAN 1. 0 Rationale for Improvement work Unstable fluid load has increasingly worsened the health quality of life for patients suffering from Acute Kidney Injury. Usually, the fluid balance is assessed by use of fluid balance charts in hospitals; however, some healthcare personnel have not effectively embraced the use of the charts, leading to further difficulties with management measures for the condition that causes increased mortality under poor management. There is need therefore to improve fluid balance among patients, to reduce the length of hospital stay, healthcare costs or mortality (Chung et al.